Donation after cardiac death following withdrawal of veno-venous extracorporeal membrane oxygenation

Brett Sampson^1,2, Ubbo Wiersema¹, Philippa Jones², Gerry O'Callaghan¹

¹Intensive and Critcal Care Unit, Flinders Medical Centre, Adelaide, Australia, ²DonateLife , SA, Australia

Donation after cardiac death (DCD) has rapidly increased throughout Australia in recent years [1,2]. Over the same period there has been increased availability of extracorporeal membrane oxygenation (ECMO); a legacy of the 2009 Influenza A (H1N1) pandemic [3,4]. With growing experience in these two practices, a new pool of potential organ donors is likely to be realised.  In Australia, ECMO is only initiated for severe cardiorespiratory failure when spontaneous recovery is expected, or as a bridge to heart (&/or lung) transplantation. Unfortunately, ECMO is not always lifesaving and sometimes it must be withdrawn to enable end of life care. It is in this cohort of patients that a new pool of potential organ donors may exist.  We present a case of a sixty year old man with severe community acquired pneumonia, complicated by acute respiratory distress syndrome, who donated both kidneys through DCD after withdrawal of veno-venous ECMO. We discuss how ECMO might influence the identification of potential organ donors, its impact on the withdrawal of life sustaining treatments and how it might be used to minimise ischaemic injury to donated organs. The international practice of initiating veno-arterial ECMO after cardiac death, solely to facilitate DCD, is not practiced in Australia and therefore is not discussed.